Médecine A - Hôpital Pasteur, 39 Avenue de la Liberté, 68024 Cedex, Colmar, France.
Eur J Cancer. 2009 Dec;45(18):3282-90. doi: 10.1016/j.ejca.2009.06.015. Epub 2009 Aug 6.
To assess the feasibility, participation and neoplasia yield of adding a flexible sigmoidoscopy (FS) once in a lifetime to a colorectal cancer screening programme with guaiac-based faecal occult blood test (gFOBT).
A total of 4771 average risk residents aged 50-74 of a canton of the Haut-Rhin, a French administrative area, were invited every other year to participate in an organised screening programme with gFOBT. Of them, those aged 55-64 (1824 people) were, in addition, invited once by mail to visit their general practitioner (GP) for a screening with FS performed by a gastroenterologist.
In all, 2717 people (56.9%) (95% confidence interval (CI) 55.5-58.4) were screened with one or other of the two tests or with both tests. Compliance was 56.7% (55.3-58.1) with gFOBT and 20.9% (19.1-22.8) with FS. Both tests were performed by 20.2% (18.4-22.1) of people. Compliance with FS was 1.9% in people who had not complied with gFOBT and 31.9% in people who complied. The latter was 50% in patients of 26 motivated GPs. The detection rate for advanced neoplasia was 17.7 per 1000 people screened (12.7-22.6) with the combined procedure, more than three times higher than that with gFOBT alone.
A population-based screening programme with the addition of FS to gFOBT is feasible and safe through an organisation involving GPs. The performances of the two screening tools are complementary: high compliance - low yield for gFOBT and vice versa for FS. The addition of a single FS screening in people aged 55-64 to an organised programme with biennial gFOBT in people aged 50-74 is a colorectal cancer screening option that deserves further exploration.
评估在基于愈创木脂的粪便隐血试验（gFOBT）的结直肠癌筛查项目中增加一次性柔性乙状结肠镜检查（FS）的可行性、参与度和肿瘤检出率。
法国上莱茵省一个行政区的一个平均风险居民群体中，4771 名年龄在 50-74 岁的居民每隔一年被邀请参加 gFOBT 组织筛查计划。其中，年龄在 55-64 岁的 1824 人（1824 人）还通过邮件被邀请一次，以便在他们的全科医生处接受由胃肠病学家进行的 FS 筛查。
总共有 2717 人（56.9%）（95%置信区间[CI] 55.5-58.4）接受了一种或两种检查或两种检查。gFOBT 的依从率为 56.7%（55.3-58.1），FS 的依从率为 20.9%（19.1-22.8）。有 20.2%（18.4-22.1）的人同时进行了这两项检查。未遵从 gFOBT 检查的人的 FS 遵从率为 1.9%，而遵从者的 FS 遵从率为 31.9%。在 26 名积极配合的全科医生的患者中，后者的遵从率为 50%。联合方案的高级别肿瘤检出率为每 1000 人筛查 17.7 例（12.7-22.6），明显高于单独使用 gFOBT 的检出率。
通过涉及全科医生的组织，在 gFOBT 中增加 FS 的基于人群的筛查计划是可行且安全的。两种筛查工具的性能互补：gFOBT 的依从率高但检出率低，FS 则反之。在 50-74 岁人群中每两年进行一次 gFOBT 的组织筛查计划中，为 55-64 岁人群增加一次 FS 筛查，可以作为结直肠癌筛查的一种选择，值得进一步探索。
